More Jewish parents decide not to circumcise

In Australia more Jewish parents are deciding not to circumcise their little boys. Writing in the SMH, Rebecca Schwartz explained the dilemma she faced when she was pregnant with a boy, her uncircumcised (non-Jewish) husband insisted that he would not be circumcised, and her traditional (east European) family demanded that he would be. She successfully resisted the expected bris on the eighth day, but since the family pressure persisted she eventually made an appointment with a paediatric surgeon, who gave her a copy of the RACP policy statement (circumcision not recommended or beneficial in Australia) and warned her about pain, harm and complications. As she reports:

Now, here I was a few months later, on my way to a secret appointment at a paediatric surgeon's clinic in Melbourne. Maybe, I imagined with a kind of crazed desperation, my son's foreskin is so tight that it has to be removed. A medical emergency! But under examination, my son's tiny penis turned out to be perfect. I felt a slight flutter of resignation at this, then shame. This was something of which any normal mother should have been proud. The surgeon explained the procedure: "No food or drink for 24 hours, then a general anaesthetic with a tube stuck down his throat. At the end of the operation, we hope he wakes up screaming, because that shows he has survived okay. His penis and scrotum will swell up like a purple eggplant and can take 10 days, maybe longer, to heal. Wearing nappies will be painful." As I quickly gathered up my perfect baby and turned to flee, he stopped me: "You know, there are quite a few Jewish families I've encountered who are secretly not circumcising their sons." The outcome: “I give thanks each day for being blessed with such a beautiful boy, and he keeps his trousers zipped at the Sabbath table.”

Infant circumcision death: Nurse guilty of manslaughter

A nurse has been found guilty of manslaughter after causing a baby's death by circumcision. Grace Adeleye, 67, circumcised four-week-old Goodluck Caubergs at an address in Chadderton, Oldham, in April 2010. The boy bled to death before he could reach hospital the following day. Adeleye was found guilty of manslaughter by gross negligence at Manchester Crown Court. The nurse, who denied the charge, had told the jury she had done "more than 1,000" circumcision operations without incident. [So much for the claim that there is “no risk” with an experienced operator.] The court heard that Adeleye and Goodluck's parents were from Nigeria, where the circumcision of newborns is traditional among Christian families. She was paid £100 to do the operation. The jury was told that she carried out the procedure using a pair of scissors, forceps and olive oil and without anaesthetic. The nurse had claimed there had been "no problem" when she left the infant and that his parents had been pleased with the operation. [Was the boy pleased?] However, the court heard that when Goodluck's parents had changed his nappy several hours later, they had found a large amount of blood and phoned Adeleye, who had told them to re-dress the wound. Goodluck's parents called an ambulance the following morning and he was taken to the Royal Oldham Hospital, where he died a short time later.

Better information means less circumcision

A study of circumcision in South Korea has found that when parents find better and more balanced information about circumcision they are much less likely to have it done. he result is a sharply falling circumcision prevalence. There is no tradition of circumcision in South Korea, but it was introduced as a “modern” idea during the United States occupation of the country following the Korean War in the early 1950s. By the 1990s the practice was nearly universal, but performed on boys in late childhood rather than infancy. In a recent study, Korean researchers have found a sharp decline in the incidence of circumcision and attribute this to better information, mainly from books and the internet, which tended to present the most comprehensive, balanced and sceptical information. Newspapers and television, on the other hand, were far more biased in favour of circumcision, and parents who relied on those sources were far more likely to want it done.

Lay Scientist says: Infant male circumcision is genital mutilation

An article by the Lay Scientist in the Guardian (UK) argues that men should have the right to choose circumcision, not have the choice forced upon them. Infant circumcision without consent or immediate medical justification is an unjustified violation of basic human rights, that shares more in common with ancient coming-of-age rituals than responsible medical practice.

German Paediatric Association criticises American Academy of Pediatrics

The German Paediatric Association (Berufsverband der Kinder- und Jugendärtze [BVKG]) has condemned the AAP’s recent circumcision policy as culturally biased, medically inaccurate or irrelevant, and inattentive to the best interests of the child. The observations were made in the course of a submission to the German parliament (Bundestag), urging that it not pass a law authorising circumcision of minors, but that boys under the age of 14 be protected from circumcision, in accordance with the Cologne court ruling. The document points out that the principal pressure for circumcision of male infants and boys is cultural/religious, not health-related, and that advocates of circumcision for ritual/religious reasons make cynical and one-sided use of the medical literature for their own purposes.

Fall in HIV infections NOT due to circumcision

A significant fall in new HIV infections in Africa and some other underdeveloped countries is not due to circumcision. According to the UNAIDS global report for 2012, “the most important factor was not nationwide billboard campaigns to get people to use condoms or abstain from sex. Nor was it male circumcision. Rather, it was focusing treatment on high-risk groups. While saving babies is always politically popular, saving gay men, drug addicts and prostitutes is not, so presidents and religious leaders often had to be persuaded to help them." UNAIDS director Michel Sidibe said that the greatest success has been in preventing mothers from infecting their babies, but focusing testing and treatment on high-risk groups like gay men, prostitutes and drug addicts has also paid dividends, said Michel Sidibé, the executive director of the agency UNAIDS. Many leaders are now taking “a more targeted, pragmatic approach,” he said, and are “not blocking people from services because of their status.” Mr Sidibe noted that fast-growing epidemics are found in countries that criminalize certain forms of sexual behavior. Homosexuality is illegal in many Muslim countries in the Middle East and North Africa - areas of nearly universal circumcision. In those places gay and bisexual men cannot risk admitting their sexual contact details, meaning that the disease can spread unchecked, exactly as syphilis used to do when it was stigmatised as a sign of immorality. The 2012 UNAIDS report is further evidence that the most important factor in the spread of HIV is not the foreskin, but the social and cultural environment.

Making a mockery of the AAP’s unsubstantiated claim that the “benefits of circumcision outweigh the risks”, two recent report show that it does not take much for that “simple snip” to ruin a boy’s life. In India a seven-year-old boy is battling for life after a circumcision surgery went wrong at a private hospital in Alwar. The boy, Imran, was admitted to Sania hospital, where he was evidently circumcised using an electro-cautery device. This caused such extensive damage to his genitals that it was necessary to remove them entirely a few days later. Meanwhile in the United States, a routine circumcision operation on a 4-year old boy went so badly wrong that the boy pleaded for his penis to be cut off completely so that he could be a girl. The circumcision operation took 90 minutes (so much for the 5-minute snip touted by the Circumcision Foundation of Australia), after which there was extensive bleeding. Following further surgery it became apparent that the boy’s urethra had been severely damaged, making it impossible for him to urinate. The boy’s parents are now suing the doctors responsible for medical negligence, deceptive trade, breach of warranty and misrepresentation.

In Britain, the nurse charged with manslaughter following the death of a baby boy (as previously reported), has come up for trial. Goodluck Caubergs died from loss of blood the day after nurse Grace Adeleye circumcised him using scissors, forceps and olive oil, but without anaesthetic, in April 2010. Goodluck's parents are originally from Nigeria, where the circumcision of newborns is the tradition for Christian families. The prosecutor told the court that as many as three children a month are admitted to the Royal Manchester Children's Hospital because of bleeding after home-based circumcisions - a danger the nurse should have been aware of. [Comment: No doubt that is true, but she was acting at the request of the parents, so they must be regarded at least as accessories to the charge.]

When the extremist Circumcision Foundation of Australia launched its current push for boosting infant circumcision to combat HIV in a Medical Journal of Australia editorial in 2010, the argument depended entirely on the claim that heterosexual diagnoses were increasing as a proportion of total infections. They wrote:

Regular surveillance indicates that HIV in Australia is slowly following the trend in Western Europe and North America toward an increased proportion of transmission occurring through heterosexual contact. Although the epidemic in Australia is likely to remain concentrated for some time among men who have sex with men, the proportion of new diagnoses attributable to heterosexual contact has risen... . This raises the question of whether low-prevalence countries such as Australia — with an increasing proportion of HIV cases attributed to heterosexual contact — should consider increasing the rate of infant male circumcision to reduce future HIV infections. [emphasis added]

This argument was not seriously challenged at the time, partly because one of the authors, David Cooper, is director of the Kirby Institute, which is responsible for monitoring HIV in Australia, and therefore a recognised authority on the matter. The claim was repeated most recently by Adrian Mindel, the CFA’s sexual health “expert”, in a Radio National circumcision debate on 15 September this year. The Kirby Institute has now released its 2011 HIV Surveillance report showing that as a proportion of total infections heterosexual transmission actually fell 17 per cent last year!

So where does that leave the CFA’s argument? Pretty much in the same place as before, since it was bogus to begin with. It is meaningless to talk about the proportion of heterosexual infections, since changes in this measure are most likely the result of incidence changes in the other, much larger category of infection, male homosexual contact. In particular, it implies nothing at all about female-to-male sexual transmission of HIV, the only route of any possible relevance to circumcision. Detailed examination of the data shows that to the extent heterosexual transmission has risen in the past decade it is driven by two factors: a near doubling in the number of infected women “from a high prevalence country” and a rise in the number of cases among males over 40, who have the highest levels of circumcision. Among heterosexual men under 30 the rates of HIV infection are virtually unchanged, despite a dramatic fall in the prevalence of circumcision in this age group.

When the 2011 surveillance report was released in October 2012 media coverage focused on the finding that the overall HIV prevalence had increased by 8% compared with 2010. They totally ignored the finding that the proportion of heterosexual infections had declined by double that amount. All the media were doing was repeating the information in the Kirby media release, which noted that “HIV continued to be transmitted primarily through sexual contact between men”, but failed to go into details. It is to the credit of Associate Professor David Wilson, the Kirby spokesman quoted in the media release, that he did not mention circumcision in his comments and observed that “some of the rise in reported HIV diagnoses could be attributed to changes in testing trends among men who have sex with men who are the most affected population group.” He added that “earlier diagnosis among these people and initiation of antiretroviral therapy would have large health benefits for the individual and reduce new infections in the community.” No mention of cutting babies here. Many studies have established that circumcision does not reduce the risk of HIV infection among homosexual men and injecting drug users.

It is a sad indictment of the CFA, and Professor Cooper (who ought to know better) in particular, that they could engage in such cynical misrepresentation of the data about such a serious issue as HIV in order to prosecute their wrong-headed drive to resurrect infant circumcision.

The Supreme Court of Canada has dismissed the appeal of a British Columbia man who tried to circumcise his four-year-old son on his kitchen floor with a carpet-cutting blade. The boy needed corrective surgery to repair the severe damage arising from the attack. In a 7-0 ruling, the justices left intact a Court of Appeal ruling that convicted the man of aggravated assault and assault with a weapon.

The man was convicted at trial in October 2009 of criminal negligence causing bodily harm and acquitted on the two assault charges. The appeal court restored convictions on the assault counts and stayed the negligence charge, conditional on the conviction for aggravated assault. The man's appeal to the Supreme Court sought to have the assault charges thrown out again, but the justices dismissed the case. The original trial was told the man felt that his religious beliefs required that his son be circumcised. Doctors advised him to wait until the child was older and stronger before performing the procedure. The Crown dismissed the religious reasoning. “This is a case about child abuse,” the Crown argued. "This is not a case about the applicant’s religious freedom or circumcision generally."

Male and child health improves as incidence of circumcision declines

Confirming previous studies summarised on this site, reports issued this year by the Australian Institute of Health and Welfare show that the health of Australian children continues to improve, and that while males generally are less healthy than women, their problems have nothing to do with lack of circumcision. Most strikingly, the infant mortality rate has more than halved since 1986, the very period during which the incidence of routine circumcision fell from around 40 per cent of boys under 6 months to around 12 per cent today. The most serious child health problems identified by the report are asthma, lack of breast feeding, and arising from social factors such as poverty and Aboriginality.

Phimosis: Circumcision outmoded treatment

A thoroughly researched article in ISRN Urology by an Indian paediatrician confirms previous research showing that phimosis (inability to retract the foreskin) is normal in children and rarely requires intervention. He further points out that circumcision is an old fashioned and outmoded response to problem cases that has largely been superseded by medical rather than surgical treatments. Unlike papers by Americans and others from circumcising cultures, this survey does not start with the usual litany about circumcision being an ancient surgical procedure, performed by many savage and ignorant cultures blah, blah, blah, but at the proper place: with a discussion of the foreskin as a normal, functional part of male sexual anatomy, followed by a discussion of its development, anatomy and physiology. Only then does the author consider the occasional problems to which a non-retractile foreskin may give rise, and the appropriate responses (i.e. not involving wholesale destruction of the body part in question). The paper points out that there are two types of phimosis - physiological (normal) and pathological - and that only the last of these may warrant surgical intervention. The author is particularly concerned that there is still widespread confusion, among both parents and doctors, between these two types of phimosis, leading to many unnecessary and unwanted circumcision procedures. Better knowledge of foreskin physiology and modern treatment options is needed to minimise mistaken diagnoses of pathological phimosis, reduce the incidence of needless and often harmful surgery.

ABSTRACT: Phimosis is nonretraction of prepuce. It is normally seen in younger children due to adhesions between prepuce and glans penis. It is termed pathologic when nonretractability is associated with local or urinary complaints attributed to the phimotic prepuce. Physicians still have the trouble to distinguish between these two types of phimosis. This ignorance leads to undue parental anxiety and wrong referrals to urologists. Circumcision was the mainstay of treatment for pathologic phimosis. With advent of newer effective and safe medical and conservative surgical techniques, circumcision is gradually getting outmoded. Parents and doctors should a be made aware of the noninvasive options [i.e. not involving cutting or removal of tissue] for pathologic phimosis for better outcomes with minimal or no side-effects. Also differentiating features between physiologic and pathologic phimosis should be part of medical curriculum to minimise erroneous referrals for surgery.

Helsinki conference issues declaration on right to genital integrity

Although it attracted no media coverage in Australia, the Helsinki conference on genital integrity represents another milestone in the battle for children’s rights. The conference heard speakers from Britain, the United States, Germany, The Netherlands and even Australia criticize unnecessary genital surgeries of all types, whether performed for medical or cultural reasons, and whether performed on boys, girls or intersex children. The conference passed a resolution in defence of the right of all children to bodily integrity - that is, to make their own decisions about their own body parts. Among the highlights of the conference was a talk by the Palestine-Swiss jurist Sami Aldeeb, “The Islamic concept of law and its impact on physical integrity: comparative study with Judaism and Christianity”, and Brian Earp’s discussion of the difference between religious and secular ethics, and why accusations of anti-semitism do not help the case of those defending circumcision of children.

Rabbi admits circumcision is child abuse

When making Cut, his documentary film on circumcision, Jewish film-maker Eliyahu Ungar-Sargon interviewed Orthodox rabbi Hershy Worch about circumcision practices. Among other comments, the rabbi said:

It’s painful, it’s abusive. It’s traumatic, and if anybody who’s not in a covenant does it, I think they should be put in prison. I don’t think anybody has an excuse for mutilating a child. … Depriving them of [part of their] penis. We don’t have rights to other people’s bodies, and a baby needs to have its rights protected. I think anybody who circumcises a baby is an abuser, unless it’s absolutely medically advised. Otherwise – what for? …

After a moment of what many viewers perceive as stunned silence, Eliyahu asks a pertinent question: "How does this covenant alleviate your ethical responsibility that you just so articulately posed? How is it that being in this covenant exempts you from that term. How can you not call yourself an abuser?" The Rabbi actually cuts him off and says:

I am an abuser! I do abusive things because I am in covenant with God. And ultimately God owns my morals, he owns my body, he owns my past and future, and that’s the meaning of this covenant – that I agreed to ignore the pain and the rights and the trauma of my child to be in this covenant.

Such honesty is rarely found among circumcision advocates. Note, in particular, Worch’s statement that only those who consider themselves to be in the Covenant created by Genesis 17 should practise circumcision of infant boys, and that anybody else who does it is a criminal.

Circumcision: Medical or human rights issue?

While circumcision promoters continue to insist on the “medical benefits” of circumcision, and the backward Australian media play along with their simplistic risk/benefit calculations, experts in human rights, bioethics, law and child health are arguing that non-therapeutic circumcision of male minors is not a health issue at all, but a question of human rights. There are not nearly sufficient health benefits in childhood to justify the removal of a functional and valued body part merely because it might be susceptible to a few problems in later life. This gloomy medical discourse, picturing the foreskin as a troublesome outlaw rather than a source of fun and pleasure, originated in the Victorian period, when circumcision of infants and boys was introduced as a means of repressing sexuality. Circumcision has always been an anomalous practice, violating all the normal rules of surgery and later principles of both bioethics and evidence-based medicine, and the reasons for this must be sought in its origins as a punishment for “premature” expressions of sexuality, particularly masturbation – a process identified by Robert Darby as “The demonisation of the foreskin” and analysed in his book A Surgical Temptation (2005).

The problem with this medical discourse is that it starts at the wrong end: “we hate the foreskin; let’s find excuses to cut it off.” Hence all those “studies” seeking to show that the foreskin is complicit in this or that frightening disease. Medical authorities should start at the other end, as they do with any other body part: the foreskin is normal male anatomy and contributes (in ways we do not yet fully understand) to sexual arousal and function; let us see what we can do to protect it from the mechanical faults and disease processes to which it may be at risk.

Latest figures show circumcision in steady decline

Circumcision in Australia is in steady decline. Calculations by an independent statistical consultant show that the incidence of circumcision among boys aged 0 to 14 years has remained steady at about 20 per cent over the past decade, while the prevalence (total number of circumcised males in the population) has fallen dramatically from 70 per cent in 1991 to 30 per centre in 2010. Contrary to the claims of anti-foreskin activists associated with the Circumcision Foundation of Australia, and despite their media blitz, there has been no increase in the incidence of circumcision in recent years. Our figures show that just under 20 per cent boys are circumcised by age 14, of which 3 per cent are therapeutic operations (to correct a problem, most likely phimosis) and over 16 per cent are non-therapeutic procedures, performed for cultural, religious or other social reasons (routine circumcision). Since the combined Jewish and Muslim population in Australia is less than 3 per cent (2011 Census), there is no reason why the incidence of non-therapeutic (routine) circumcision should be as high as this. Allowing for medically necessary procedures and the wishes of parents from cultures that traditionally practise circumcision, the incidence of circumcision could easily be cut by half, to less than 8 per cent of boys by age 14. In Denmark and other countries of Scandinavia, the figure is about 4 per cent. We challenge the Royal Australasian College of Physicians to make this a primary goal of their child health program.

In favour of children’s rights: Child’s right to bodily integrity

In the wake of the Cologne decision and the resulting debate as to whether circumcision of male infants and boys is lawful, a group of German child health, bioethical and human rights experts have established a new organisation called Pro-Kinderrechte - In favour of the rights of children. The site has a simple message, inscribed on its masthead image of a child with his hands clasped in front of his private parts: “Mein korper gehort mir” - My body belongs to me. The theme and argument of the group is that “Zwangbeschneidung ist Unrecht - auch bei Jungen” - Circumcision without consent is unlawful, even when done to boys. There is a comprehensive FAQ on circumcision in English.

In The European magazine (8 Sept 2012), Gert van Dijk, bioethics expert at the Royal Dutch Medical Association, argues that Circumcision infringes on a child’s right to physical integrity and religious freedom. A powerful policy of deterrence should therefore be established: His body, his choice. Read full article at The European

Bioethics expert criticises AAP circumcision policy

The AAP circumcision policy has been criticised by a professor at the prestigious Hastings Center for Bioethics. In a commentary posted on their bioethics forum, Elizabeth Reis observes that the AAP has been flip-flopping about circumcision since 1971 - or as we would prefer to say, tossing and turning. In 1971 there was no indication for circumcision of infants; in 1989 there were “good medical reasons” for it; by 1999 those reasons had disappeared; and in 2012 they are back again. Such shifts in opinion can hardly be the result of accumulating medical evidence - which remains as contradictory, contested and uncertain as it ever was - much less of changes in human anatomy. They are simply the result of the shifting balance of power on the policy committee: one year the anti-circumcision group has the edge; next year the pro-cutters get the majority. It’s really no way to reach decisions that have such an important bearing on the future health and happiness of millions of boys. Professor Reis concludes with a very important point: while the decisions of the AAP are reversible, those of parents influenced by their policy are not. What she means is that policies can be changed, but once a boy’s foreskin is taken away it cannot be restored. In making medical decisions for children, parents must therefore remember the open future principle and take care not to do things that they cannot undo. Childhood is a passing phase; circumcision is for ever. Given the AAP’s history of indecision, it is a certainty that in a few years time they will dump this policy and issue a new one stating that the risks and harms of circumcision outweigh the benefits. What compensation will the AAP then offer to all those boys who have been deprived of their foreskins as a result of parents believing and acting on what it said in 2012?

Confused American pediatricians release 1912 circumcision policy

The response to the “highly anticipated” policy on circumcision of male infants released recently by the American Academy of Pediatrics has been, to put it mildly, rather less than warm. Ignorant, lacking ethics, biased, full of non-sequiturs and contradictions, not evidence-based, out of date, epidemiologically incompetent and an embarrassment to the AAP are a few of the more courteous responses. Pack of lies, ridiculous, a lame camel produced by a squabbling committee, arrant nonsense from start to finish, what you would expect from a cage of monkeys playing with a typewriter are among the more printable of the less courteous ones. Even the New York Times, normally the most rabidly pro-circumcision newspaper in the United States, greeted it coolly, with the skeptical headline “Benefits of circumcision SAID to outweigh the risks”, suggesting that it was not really convinced. Already numerous critiques have appeared on independent websites and blogs, and critical letters are filtering into the AAP’s journal Pediatrics. As most critics point out, the most glaring fault in the policy is the contradiction between its conclusions that circumcision is not necessary and not recommended, and its recommendations that parents should be able to get their boys done whenever they wish, for any reason at all, and have the operation paid for by government health insurance. The overriding concern here would not appear to be the health and best interests of the child, but the desires of his parents and the financial interests of medical practitioners.

Other critics have noticed the completely wrong, and very harmful, advice given about foreskin retraction and care. Despite an avalanche of studies showing that it is perfectly normal for the foreskin not to become mobile and retractable until puberty, and that is harmful to hurry the process of foreskin separation, the AAP declares that it should be retractable as early as 2 months after birth, and further suggests that if it is not, force should be applied. It also retails the harmful advice that the interior of the foreskin should be washed with soap – despite common knowledge that soap can irritate the sensitive tissues and induce eczema and other skin problems. Premature retraction, moreover, is frequently a cause of phimosis, paraphimosis and urinary tract infections. So bizarre is this throwback to the medical wisdom of the late Victorian period, with its dogma that “congenital phimosis” was an indication for early circumcision, that we must assume that there has been a clerical error in the AAP office. Instead of releasing their 2012 policy statement on circumcision, and as a consequence of a careless clerk making a few typos, the AAP has released its 1912 policy. This simple error could explain everything. Critiques of the AAP policy are appearing rapidly, for example:

Foreskin has important sexual function: New research

Research by scientists in Slovenia has confirmed previous research, common knowledge and much personal testimony that the foreskin has an important sexual function. A paper by Simon Podnar, published in BJU International – the world’s leading urological journal – found that a reflex action known as the “penilo-cavernosus reflex” is rarely experienced by circumcised men. What this means in ordinary language is that circumcision, by excising the most important nerves of the penis, makes it less sensitive and less functional. The is result that men who retain their foreskins experience greater sexual excitability, better orgasm control and more pleasure. Writing in response to the article, Australia’s Greg Boyle welcomed the article for further developing the work of the late John Taylor and actually doing some objective, scientific investigation of the functions of the foreskin. This was a refreshing change from the ideologically-driven propaganda that pours out of the United States, more interested in exterminating foreskins than in understanding them. In fact, the foreskin is such a miracle of biological engineering that to destroy one without genuine need is an act of wanton vandalism. As Professor Podnar comments, “I see the prepuce as an ingenious device engineered to provide a strong sensory stimulation in a slippery environment”, the evolutionary purpose of which is to maximise the desire to reproduce.

Tasmanian law report recommends regulation of circumcision

A report by the Tasmanian Law Reform Institute has condemned the open slather approach to non-therapeutic circumcision of male minors and recommended much tighter regulation of the practice. The report analyses the borderline legal status of circumcision in Australia and the risks this uncertainty creates for both boys and circumcision practitioners, and makes fourteen recommendations for reform. These include a proposal for the outright prohibition of medically unnecessary circumcision of “incapable minors” (infants and young boys), with an exception for recognized religious and ethnic groups who traditionally practise circumcision (Jewish, Muslim and some Aboriginal communities). The report also recommends that circumcision always require the authorization of both parents, and that if parents disagree about whether a boy should be circumcised the operation may not be performed unless authorized by a court. It also proposes uniform standards of competence, disclosure and operational procedure for providers of circumcision services.

The report has been hailed by child health and human rights experts as an impressive first step towards giving boys some degree of protection against needless destruction of their foreskins. Dr Robert Darby told Circumcision Information Australia that the report was a trailblazing effort that raised the discussion of non-therapeutic circumcision of minors to a new level. “For its scientific precision, its comprehensiveness, its human rights and bioethical awareness, and the good sense and practicality of its recommendations, the report could hardly have been bettered”, Dr Darby said. “Even though the recommendations apply only to Tasmania, any reforms there will set a new benchmark that other states will have to consider, and by which their own efforts at child protection will be judged. Coming on top of the Cologne decision that non-therapeutic circumcision is bodily harm, the TLRI report further revolutionizes the debate: the issue is no longer whether circumcision has so called “health benefits”, but whether it is legally and morally permissible.”

STI and HIV risk not reduced by circumcision: New study

A study of men attending a sexually transmitted diseases clinic has found that circumcised men reported significantly (but not greatly) more STDs in their lifetimes, were more likely to have been diagnosed with genital warts, and were more likely to have HIV. The 660 men in the sample were randomly sampled from an STD clinic waiting room. Almost a third of them were circumcised. Did you get that: despite what the circumcision promoters say, sexually transmitted infections and HIV were were more common in the circumcised men. The abstract of the article in the Journal of Sexual Medicine follows.

Introduction. Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence.

Aim. In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico.

Methods. Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room.

Main Outcome Measures. We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit.

Conclusions. These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.

Circumcision of boys should be discouraged: Dutch ethics expert

In a recent article in the Catholic News (Amsterdam) Gert van Dijk, chair of the bioethics committee of the Royal Dutch Medical Association, defended the association’s policy of opposing and discouraging non-therapeutic circumcision of boys. He points out that there is no medical reason why boys or other male minors should be circumcised before they can give informed consent, that the foreskin plays a significant role in male sexual response, and that complications from the operation are common. He also argues that circumcision for religious or cultural reasons fails to respect the physical integrity of the child and his own freedom of religion, and thus violates accepted principles of human rights, including the United Nations Convention on the Rights of the Child. This treaty (ratified by Australia) requires signatories to work towards the elimination of traditional practices prejudicial to the health of children. This provision of the convention is widely interpreted as applying to girls (thus protecting them from cultural traditions such as female genital mutilation), but the wording is children rather than girls and so must be interpreted to apply to boys as well.

Graeme Reeves, the doctor (eventually) convicted of genital mutilation after unnecessarily excising a female patient’s external genitalia, is appealing against his 2-year gaol sentence on the ground that he was only trying to protect the woman’s health. His barrister even tried to argue that the case should not have come to a criminal trial at all, since he “believed” that what he was doing was for the benefit of his patient. As we commented last year, we have heard this sort of defence before – every time an enthusiast for circumcision tries to justify the amputation of part of a boy’s external genitalia. This defence will not hold, as doctors can believe (or say they believe) all kinds of cock and bull; the justification for surgical removal of functional body parts is not that a doctor “believes” such an excision to be in a person’s best interests, but if the operation is generally accepted by the medical profession as necessary in the circumstances and the patient has given explicit consent. Without such consent, any interference with another person’s body is assault.

Meanwhile, the Royal Australasian College of Physicians has raised the stakes by issuing a new policy statement on female genital mutilation that takes a firm stand in defence of the bodily integrity and human rights of girls and women. According to the policy, FGM is an injury to the external genitals; it is usually performed on girls between infancy and 15 years of age; it causes harm; it violates the human rights of the victims; it is wrong because it is performed on minors without consent; it is illegal in all Australian states; and, although it is a practice authorized and recommended by some cultural and religious minorities, it is unacceptable in Australia. We note that all these objections also apply to medically unnecessary circumcision of male minors, and wonder why the RACP needs separate policies on male circumcision and female genital mutilation. Why not a single policy covering surgical operations on both the male and female genitals, recognizing the right of everybody (not only females) to bodily integrity?

Morris, Wodak circumcision campaign falls flat

Recent restatements of the (nineteenth century) case for routine circumcision of normal infants by Brian Morris, Alex Wodak and their motley supporters in the Circumcision Foundation of Australia have attracted huge media attention. Unfortunately for them (and fortunately for Aussie boys) they have made very little headway and have also aroused vigorous opposition. Writing in The Conversation, two human rights experts argue that even if Morris and Co’s arguments about health benefits were valid (which they are not), it would still not be permissible to perform amputative surgery on a non-consenting minor because such an action would be a blatant violation of his human rights. As they point out, “Circumcision without consent or any immediate medical necessity on a healthy adult male would clearly be in breach of his human rights. So how is infant male circumcision without consent any different?” Morris and Co refer monotonously to the right of parents to choose medical procedures for their children, forgetting that this right is confined to beneficial and recommended treatments that are unquestionably in the child’s best interests. Unnecessary surgical amputations, especially those on a boy’s best friend, are not in this category. It is not as though a boy can get his foreskin back when he turns 18: childhood is a passing phase; circumcision is for ever.

On top of this stinging rebuff, a poll of medical and health personnel has found that more than half the respondents believe that non-therapeutic circumcision of minors is outright child abuse. The poll in Australian Doctor showed that 51 per cent believed that circumcision was chid abuse and should not be done at all, while a further 23 per cent believed that it was an individual choice that should not be available in public hospitals or funded by Medicare. A mere 2 per cent believed that all boys should be circumcised. Rumour has it that from now on Professor Morris will be known as Professor Two Percent.

Africa: Circumcision campaigns failing to reduce HIV incidence

Despite hundreds of millions of dollars in medical and humanitarian aid poured into poor African countries as part of the campaign to persuade, coerce and bribe men to get themselves and their children circumcised, there is no evidence that circumcision has had any effect in reducing the incidence of HIV infections. On the contrary, surveys continue to show that there is no consistency in the pattern between circumcision incidence and the level of HIV infection, and in places where particularly aggressive circumcision campaign have been launched, such as Zimbabwe, the incidence of HIV is higher among the circumcised. Is it tragedy or farce?

Canada: Human rights campaigners seek protection for foreskin

A group of Canadian human rights campaigners are calling on the College of Physicians and Surgeons of British Columbia to take a stronger stand in defence of children and against medically unnecessary (non-therapeutic) circumcision of infants and other minors. Glen Callender, founder of the first ever Foreskin Pride March, wants to see the Criminal Code amended to include foreskins in the list of specified sexual organs that cannot be mutilated or removed before the age of 18. The College’s official stance is that routine infant circumcision is a cosmetic, medically unnecessary procedure, with risks that outweigh the benefits. “The bottom line here is that here in Canada we protect the genitalia of girls from any kind of unnecessary surgery until they’re 18 years old, and then they have the right to modify their vulva as they see fit,” Callender told the Vancouver newspaper Metro. “If girls have that right, then boys and intersex kids should have the same right. The Canadian Charter of Rights and Freedoms guarantees equal protection under the law.”

Circumcision “Not in child’s best interests”: Child health expert

Germany’s leading child health expert, Professor Maximilian Stehr, has condemned non-therapeutic circumcision of male infants and boys as medically unnecessary and not in the best interests of the child. In hard-hitting article for Spiegel International, he argues that the first duty of doctors is not to harm their patients, and that medically unnecessary circumcision “causes damage because it results in an irreversible loss of healthy bodily tissue”. It also carries serious risk of surgical and anaesthetic complications, sometimes leading to death or permanent disablement. He points out that the foreskin has both protective and sexual functions, and that even if it were true that circumcision reduced the risk of infection with a few sexually transmitted diseases in adulthood (an unproven point), the operation would not need to be done in infancy or childhood: to gain the same claimed benefit, it could wait until the boy was old enough to understand the issues and make his own decision. (Professor Stehr is a pediatric surgeon at the University Hospital in Munich and chair of the working group on pediatric urology of the German Association for Pediatric Surgery.)

“Circumcision requires consent of the individual”

A leading German paediatrician has welcomed the ruling of the Cologne court that non-therapeutic circumcision of children constitutes physical harm and is unlawful. In an interview with Deutsche Welle Dr Maximilian Stehr, chair of the paediatric urology working group of the German Association of Pediatric Surgery, said that unnecessary operations should not be performed on individuals who cannot give consent. In the case of children they should delayed until they are old enough to make an informed choice. Dr Stehr points out that the ruling did not change the law and that changes to the law are not needed. What is required is respect for the child’s rights, both to physical integrity and the right to make his own decisions about surgical alterations to the most private parts of his anatomy.

“Law should protect bodily integrity”: Adelaide law lecturer

In a thoughtful and well-informed discussion of the Cologne court’s judgement on (“religious”) circumcision of male minors, Adelaide law lecturer Cornelia Koch discusses the cultural background to the case and the court’s decision, and then reflects on whether it is time to rethink the Australian attitude to male circumcision. She concludes:

In my view, a procedure which started in Australia for dubious medical reasons (that it could prevent masturbation, syphilis etc) and then became culturally entrenched should not be continued simply because it has become part of mainstream culture. Most medical bodies in Western countries including Australia now agree that it is medically more risky to have a circumcision than not to have one. We should take a long, hard look at allowing parents to determine that their boys should be circumcised for no convincing rational reasons. There appears to be a societal change in Australia as the rate of circumcision is in decline. It may be time for the law to catch up and prohibit male circumcision unless it is required for pressing medical reasons, or is performed on a consenting adult. This would bring the law in line with current medical knowledge. Laws should not be based on overcome cultural ideals, particularly when it comes to the protection of the bodily integrity of a very young person.

Circumcision not recommended as cancer preventive

The Cancer Council of Australia has come out strongly against recent claims that mass circumcision of boys is necessary as a preventive of cancer of the penis and prostate. In a statement released on 21 June, the Council warned that cancer of the penis was a rare disease in Australia, and that the evidence of circumcision having a protective effect was not sufficient to justify the operation. As to prostate cancer, the main risk factor was nothing more than getting old - a natural process that circumcision could do nothing to arrest. The statement concluded: “Taking into account these issues, the relatively lower burden of potentially preventable disease in Australia, and the complex cultural, ethical and legal issues surrounding the practice of circumcision, Cancer Council Australia does not recommend circumcision as a routine cancer-preventive procedure at this time.”

Over 93 per cent of Aussie boys will never have a medical problem that requires circumcision

A recent post on Bubhub refutes recent claims by Brian Morris, Terry Russell and collaborators at the so-called Circumcision Foundation of Australia that universal circumcision of infants is necessary to prevent epidemics of foreskin-related disease in adulthood. Using data from the National Morbidity Database, the Australian Studies of Health and Relationships research database and the Australian Bureau of Statistics the author shows that 93 per cent of boys will never develop any kind of foreskin-related problems or disease that circumcision might have prevented. He also shows that even if universal circumcision did prevent a few thousand cases of adult disease, these benefits would be outweighed by the surgical complications and the huge financial burden. The author notes that since at least 93 per cent of boys will never require a circumcision, inflicting circumcision on them so to avoid the possibility would be both pointless and a wicked violation of their human rights and bodily integrity.

German court rules non-therapeutic circumcision of boys unlawful

Hot on the heels of a resolution of the Finnish Greens that non-therapeutic circumcision of children should be prohibited, a district court in Cologne, Germany, has ruled that non-therapeutic circumcision of children, even when performed for religious reasons at the request of a boy’s parents, is unlawful, and that those responsible are guilty of inflicting bodily harm. The case arose from a 4-year old boy circumcised by an Islamic doctor who later suffered severe bleeding requiring emergency medical care. The case has far-reaching implications for the future of medically unnecessary circumcision of minors and the human rights of children. Meanwhile in Britain, doctors and human rights advocates are urging the British Medical Association to put an end to unnecessary circumcision of male children.

Aussies give thumbs down to circumcision

Despite all the tedious propaganda from circumcision promoters, recent polls in Australian newspapers suggest that attitudes against circumcision are hardening. A poll in the Sydney Morning Herald that accompanied its debate on whether Medicare should continue to cover what it called “elective circumcision” showed that 67% of respondents were in favour of dropping medically unnecessary circumcision from the Medical Benefits Schedule. This result was all the more impressive considering that the phrasing of the question was rather misleading. “Elective” implies a procedure freely chosen by an informed and consenting adult, not an operation imposed on a non-consenting child. Had the question been phrased more accurately (as non-therapeutic or medically unnecessary circumcision) it is likely that the vote against continued coverage would have been even stronger. The SMH showed further pro-circumcision bias by including a picture with a quote from Brian Morris, representing the Circumcision Foundation of Australia, moaning about poor parents not being able to afford the high cost of getting their boys circumcised. What a ridiculous argument: being poor is bad enough; why should poor people be deprived of their foreskins as well?

Even more strikingly, a poll taken by the Hobart Mercury found that more than 80 per cent of respondents were actually in favour of making (medically unnecessary) circumcision of infants illegal. The poll was connected with an article announcing that the Tasmanian Law Reform Institute had completed its inquiry into the legal status of circumcision and was soon to release its report. It is most unlikely that the report will recommend making circumcision illegal, but it may be expected to propose stricter regulation of the practice. In fact, any regulation at all would be strict compared with the existing open slather that allows a single parent to get a boy circumcised against the express wishes of the other parent, as recently occurred in New South Wales, and a few years ago in Bundaberg.

Circumcision requires full anaesthesia

An article in the latest issue of the Australian journal Anaesthesia and Intensive Care argues that if circumcision must be performed, full anaesthesia and post-operative pain control are required. No adult would consent to be circumcised if he was not assured that the operation would be pain-free, and even greater consideration should be shown to vulnerable groups like children, especially when they have not even asked for the operation. Some circumcision practitioners are likely to complain that ensuring full pain control will be inconvenient; they forget that the object of medical treatment is not the convenience of the service provider, but the welfare of the patient. If an operator cannot ensure a pain-free operation he should not be performing circumcisions at all.

ABSTRACT: Circumcision is painful surgery and appropriate intraoperative anaesthesia and postoperative analgesia is required. This is recognised in the policies of the Royal Australasian College of Physicians and the majority of Australian State Health Departments. Nevertheless, anecdotal evidence exists that neonatal circumcision continues to be performed in Australia with either no anaesthesia or with inadequate anaesthesia. This paper presents the evidence that neonatal circumcision is painful and reviews the available anaesthetic techniques. The authors conclude that general anaesthesia is arguably the most reliable way of ensuring adequate anaesthesia, although this may mean deferment of the procedure until the child is older. Local or regional anaesthesia for neonatal circumcision ideally requires a separate skilled anaesthetist (other than the proceduralist) to monitor the patient and intervene if the anaesthesia is inadequate. Topical anaesthesia with lignocaine-prilocaine cream is insufficient.

Male circumcision “an assault”, says Irish surgeon

Routine circumcision in male infants is a potentially dangerous and unnecessary procedure, according to a Dublin surgeon, who has dismissed the rationale for the procedure as unproven and without medical justification. Dublin consultant plastic surgeon Mr Matt McHugh said circumcision was a form of genital mutilation that exposed patients to a number of health risks. Writing in the latest issue of Modern Medicine, the Irish journal of clinical medicine, Mr McHugh said: "There is no rationale for carrying out this extremely painful, traumatic and potentially dangerous procedure on male infants. "While female genital mutilation (FGM) is banned in Ireland and regarded as a serious assault, circumcision, which is a form of male genital mutilation, is not illegal, with the procedure still undertaken by some doctors."

Complications that can arise from circumcision include haemorrhage (bleeding) and infection, Mr McHugh said. "Circumcision, like any other operation, is subject to the risk of haemorrhage and sepsis. Infection is also fairly common. Occasionally, infection may lead to more serious complications such as partial necrosis of the penis, or it may be a source of septicaemia." Meatal stenosis, which causes symptoms of painful urination, increased urinary frequency and inability to control urination, is a potential late complication of circumcision, according to Mr McHugh. Loss of penile skin may also occur.

Mr McHugh said the reasons put forward for circumcision are "unproven and have no scientific basis of fact". In cases of clinically significant and persistent ‘phimosis' - a condition where the foreskin cannot be fully retracted, and the most common indication for non-religious circumcision - simple measures can be taken to correct the problem. There is a common belief that the circumcised man runs a lessened risk of venereal infection, particularly AIDS and syphilis, but there are few figures to support this, Mr McHugh said.

Medicare should not pay for medically unnecessary circumcision

A recent review of Medicare found evidence that between 2 and 3 billion dollars are spent inappropriately each year. The review, by Dr Tony Webber as Director of the Professional Services Review, noted that Medicare’s no-questions-asked policy led to serious financial abuses and failed to take account of the medical business environment. “The MBS [Medical Benefits Schedule] is riddled with misdirected incentives for practitioners … and has many examples of good public policy being thwarted by the MBS rules”, Webber writes. Among the scandals, he mentions cases where “the Safety Net was used in effect to subsidise cosmetic procedures such as surgery for designer vaginas at $5000-$6000 each” (Tony Webber, “What is wrong with Medicare?”, Medical Journal of Australia, 16 January 2012.)

What is equally scandalous about Medicare is that it continues to subsidise cosmetic procedures such as surgery for “designer penises” – namely, non-therapeutic (medically unnecessary) circumcision of male infants and boys. There is no reason at all why the over-stretched health budget should continue to waste taxpayers’ money by paying for an operation, usually on non-consenting children, that medical authorities judge to be medically unnecessary, risky, potentially harmful, and contrary to accepted principles of medical ethics and human rights, including the principle of gender equity. It is high time that medically unnecessary (non-therapeutic) circumcision was dropped from the Medical Benefits Schedule, and Medicare confirmed to its stated requirement to cover only “procedures that are clinically necessary”.

Circumcision not recommended for urinary tract infection

A study in the latest (April 2012) issue of the (Australian) Journal of Paediatrics and Child Health reviews the treatment and prevention options for urinary tract infections (UTI) in children. It finds that a UTI occurs in approximately 8% of girls and 2% of boys by 7 years of age, and outlines the best treatment options, depending on the nature of the infection and whether it recurs. The study does NOT recommend circumcision except in the few cases where recurrent episodes have failed to respond to medical (mainly antibiotic) treatment.

More circumcision death and injury

Further reports of circumcision death and injury arrive from Britain, Pakistan and Israel. In Britain, a nurse-midwife has been charged with manslaughter in relation to the death of a baby boy arising from circumcision in 2010. Grace Adeleye, 66, of Salford is alleged to have caused the death of Goodluck Caubergs by gross negligence two years ago. The tragedy has inevitably shone the spotlight once again on circumcision, with organisations such as NORM-UK and the Men’s Network in Brighton condemning the practice. The network's strategic director Glen Poole said: “In the UK we are still subjecting an estimated 100 boys a day to non-consensual, medically unnecessary circumcision – with two-thirds of these procedures being carried out for non-religious reasons. While it is illegal to tattoo a boy either with or without his consent, parents do not need their son’s consent to have his foreskin painfully and unnecessarily removed without anaesthetic by non-medical practitioners.” Men’s Network CEO Peter Baker said “Male circumcision is often viewed as an anodyne procedure – in stark contrast to the barbarity of female circumcision – but it is actually a potentially highly dangerous practice about which we need a full public debate sooner rather than later.” The Network will be holding a national conference on the issue in Keele in July. David Smith of NORM-UK, a charity offering support for men unhappy with circumcision, said: “This is not the first case of a death following a circumcision.”

In other news, in Pakistan a 15-day old boy died after an injection [presumably an anaesthetic] given prior to his intended circumcision (Pakistan Today, 16 April 2012), and in Israel a mohel performing a traditional circumcision on a 8-day old boy cut off a third of his penis, requiring him to be rushed to hospital for an emergency operation to stop him bleeding to death (Algemeiner, 18 April 2012).

One fears that these reports are no more than the tip of the iceberg.

Rising incidence of HIV and syphilis in Israel

A sharply rising incidence of HIV, syphilis and other sexually transmitted infections in Israel is worrying medical authorities and casting further doubt on claims that circumcision provides “strong” protection against such diseases. Two articles and an editorial in the March 2012 edition of the Israeli Medical Association Journal describe a “resurgence” of syphilis and HIV, especially among men who have sex with men in Tel Aviv, and warn of the risk of an “epidemic” affecting the heterosexual population. The studies are unsure of the reasons for the resurgence, but lay the principal blame on the rise of unprotected sex, as a result of treatment optimism, condom fatigue and the use of “disinhibiting substances”, such as alcohol and other drugs. They also mention the effects of big city life, which nurtures the growth of sexual sub-cultures and wide-ranging sexual networks, with increased opportunities for taking multiple sexual partners and fast, anonymous sexual encounters.

What is particularly significant about these explanations is the absence of any reference to circumcision. Researchers did record the circumcision status of clients at one STD clinic, but found no statistically significant correlation between lack of circumcision and greater susceptibility to venereal infections. These conclusions certainly provide no support for the contention of circumcision advocates, such as Brian Morris and buddies, that universal and ideally compulsory circumcision of infants is necessary to prevent epidemics of STIs in Australia. For obvious cultural reasons, Israel already has universal, semi-compulsory circumcision of infants, and it is still experiencing an alarming increase in the incidence of HIV, syphilis and other STIs. It is thus clear that behavioural factors, such as numerous sexual partners and failure to practise safe sex, are far more important than anatomy in explaining the rise of these health problems. In other words, lay off the foreskins of innocent children, and worry about the behavioural choices of randy adults!

Source: Itzchak Levy, The Resurgence, in Israel, of Human Immunodeficiency Virus and Syphilis among Men Having Sex with Men, Israeli Medical Association Journal 14, March 2012, 166-167

Last year Circinfo.org reported a study by Danish researchers which found that circumcision reduces sexual satisfaction not only in circumcised men, but also in their female partners. The study by Morten Frisch et al, published in the International Journal of Epidemiology in October 2011, examined the association of male circumcision with a range of sexual measures in both sexes. It found that circumcision was “associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment.”

Not surprisingly, these conclusions did not please circumcision advocates such as Brian Morris, who has set himself the daunting task of proving not only that circumcision is a “biomedical imperative for the 21st century” for assorted "health" reasons, but also that that the amputation of the foreskin has no impact at all on sexual function (and may even improve the operation and appearance of of the penis). He fired off a lengthy critique in reply, denouncing Frisch’s motives as much as his methodology. In his response (International Journal of Epidemiology, February 2012), Frisch not only debunks these criticisms, but reveals that following publication Morris sent emails to his supporters, urging them to send letters of complaint about the article to the editors of the journal, and (what is worse) disclosing the fact (meant to be kept confidential) that he was one of the original peer reviewers and had recommended that the paper not be published at all. Compromising the confidentiality of the peer review process in this manner is a serious breach of publication ethics. In his dignified reply to this blatant lobbying, Frisch highlights the implausibility of Morris’s attempts to portray himself as a “neutral and unbiased authority” on the “medical benefits” of circumcision, while attacking anybody who dares to disagree with him as ideology-driven anti-circumcision activists. He points out that Morris obviously has his own agenda, revealed in an impressive record of anti-foreskin activism going back to the 1990s. Frisch defends the conclusions of his own study as supported by good evidence and casting grave doubt on optimistic (?) claims that circumcision has no impact on sexual function.

Father's anguish at circumcision of son

A New South Wales father was so distressed at the unauthorized circumcision of his baby boy, and by the bland indifference of the authorities to whom he appealed for justice, that he has set up a website to explain his case. The man, Peter – who wishes to remain anonymous to protect the identity of his son – told Circinfo.org that his 6-week old son was circumcised at his partner’s request while he was overseas on a business trip. But he does not blame his partner nearly as much as the doctor who performed the surgery. “She was a victim of the blatant untruths that are spread to justify circumcision – well-meaning but ignorant. She thought that because I was circumcised I would want the boy to be done, or that all boys were circumcised as a matter of routine. I blame the doctor for three unforgivable omissions: failing to tell my partner that circumcision is very much a minority practice these days; failing to give her a copy of the Royal Australasian College of Physicians policy, which states clearly that circumcision is not widely practiced here, and is certainly not recommended; and, most importantly, for failing to obtain my explicit, written, informed consent as the other parent.”

Circumcision deaths and injury on the rise

It has been a bad few months for circumcision advocates, as more cases of circumcision-related death and injury come to light. In New York a baby died of herpes after having been infected during a routine ritual circumcision operation, in Samoa no fewer than 23 boys suffered severe injuries to their penis while being circumcised by an incompetent operator, and in Malaysia a boy has sued for damages arising from injuries suffered during his circumcision. The case in New York is one of many in which herpes have been communicated to the infant through metsitsah, a phase of the Jewish circumcision rite introduced around 600 AD, and still followed by the ultra-orthodox, which requires the mohel (operator) to suck the blood from the wound after cutting off the foreskin. This unhygienic practice was banned in most European countries in the late 19th century, but is still permitted and defended in the United States in the name of cultural relativism and religious freedom.

In Samoa (as in Fiji and some other south Pacific islands) boys are traditionally circumcised in late childhood as part of an initiation into adult responsibility. In this case the boys were circumcised by an unqualified and clearly incompetent operator and suffered severe injuries, including bleeding and infection. The operator, a 68-year-old man, has been charged with 23 counts of illegally performing an operation and causing bodily harm.

In Kuala Lumpur 14-year-old boy has sued the Federal Territory Islamic Affairs Department and two others for negligence during a circumcision, which he claimed had left his "sexual function doubtful.” Mohamad Muhammad Farhan, who sued through his father Ishahak Mak, said he had suffered severe injuries to his private parts as well as emotional and psychological disturbance due to their negligence after taking part in a mass circumcision programme on Nov 16, 2008. The programme was organised by the Department of Islamic Affair and Sunathrone, manufacturers of a commercial circumcision clamp. In the lawsuit filed on Nov 14, Muhammad Farhan claimed that the defendants had failed to ensure that there was no injury to his private parts during the circumcision. He said Sunathrone had failed to ensure that it had sufficient and experienced doctors to conduct the circumcision, alleging that he suffered pain on his private parts and had to undergo other surgeries. He claimed that he had suffered pain and could not urinate the day after the circumcision. Muhammad Farhan said a government hospital specialist had since advised him that the condition of his "sexual function" at present was "doubtful".

Meanwhile in the Netherlands, investigations into allegations of sexual abuse by priests have revealed that boys were castrated by the Dutch Catholic Church in 1950s

At least 10 teenage boys or young men under the age of 21 were surgically castrated "to get rid of homosexuality" while in the care of the Dutch Roman Catholic Church in the 1950s. Evidence of the castrations has emerged amid controversy that it was not included in the findings of an official investigation into sexual abuse within the church last year. The NRC Handelsblad newspaper identified Henk Heithuis who was castrated in 1956, while a minor, after reporting priests to the police for abusing him in a Catholic boarding home. Joep Dohmen, the investigative journalist who uncovered the Heithuis case, also found evidence of at least nine other castrations. "These cases are anonymous and can no longer be traced," he said. "There will be many more. … Mr Heithuis died in a car crash in 1958, two years after being castrated at the age of 20, while under the age of majority, which was then 21. In 1956 he had accused Catholic clergy of sexually abusing him in his Church run care home. … Sources told Mr Dohmen that the surgical removal of testicles was regarded as a treatment for homosexuality and also as a punishment for those who accused clergy of sexual abuse. Minutes of meetings held in the 1950s show that inspectors were present when castrations were discussed. The documents also reveal that the Catholic staff did not think parents needed to be involved.

Child health experts slam “new” circumcision proposal

Recent calls by Brian Morris and friends for the introduction of routine circumcision have been dismissed by health experts as nothing more than the “blinkered ideology” that Morris has been “peddling for years.” These were the words of paediatric surgeon Dr Neil Price, commenting on a recent article that collected a pile of pro-circumcision studies in order to attack the recently-released policy of the Royal Australasian College of Physicians. Meanwhile in Sydney the head of the AIDS Council of New South Wales, Nicolas Parkhill, condemned Morris’s call for mass circumcision as a response to Australia’s HIV problem, pointing out that in Australia (unlike Africa) HIV was largely confined to homosexual men and injecting drug users, neither of whom could derive any risk reduction from circumcision. “ACON does not support the implementation of male circumcision as a HIV prevention strategy in Australia,” Mr Parkhill said.

Other child health experts in New Zealand were equally dismissive. The president of the NZ Paediatric Society, Dr Rosemary Marks, said while there might be “some small benefits” arising from circumcision, they were not enough to warrant funding the procedure. “I think that’s a very long bow to draw.” Compared to the other priorities for health care, this would be very low on the list. Auckland paediatric surgeon James Hamill referred to the policy of the Royal Australasian College of Physicians, that routine circumcision was not warranted in Australia or New Zealand, as the consensus among child health authorities. The benefits of circumcision (if any) had to be viewed in context, he said, remembering that Australia and New Zealand do not have the problems faced by so many impoverished and underdeveloped African countries, and that children do not run the risks encountered by sexually promiscuous adults: “We don’t live in a desert, or in a country with a high rate of HIV, so in different cultural or geographical context it may be different.”

The article by Morris and friends was published in an on-line journal called Open Journal of Preventive Medicine – an obscure, low-status publication that nobody had ever heard of until now. The article itself contains little or nothing new, but is merely a rehash of the same material that circumcision promoters have been peddling for the last decade, including totally exploded claims about lack of circumcision being a risk factor for prostate cancer. What next: circumcision as a preventive of epilepsy and a cure for brass poisoning? As one sceptic was heard to remark, just because you call an opinion “an evidence-based policy” does not mean that it is a fair-minded survey of all the relevant evidence, or that it is anything more than the personal opinion of the true believers who put their names to it.

RACP releases circumcision guide for parents

Sydney, March 2012: A guide for parents on the vexed question of circumcision has been released by the Paediatrics and Child Health Division of the Royal Australasian College of physicians – Australia’s premier medical authority. In simple language, the leaflet outlines the functions of the foreskin, the risks and harms of the operation, the possible (slight) benefits in later life, and some of the bioethical and human rights issues relevant to making an irreversible decision about an important part of another’s person’s body – a decision that he will have to live with for the rest of his life. The doctors responsible for the advice state clearly that “newborn baby boys do not need to be circumcised unless there is a medical reason” – that is, unless there is a genuine, diagnosed medical problem that must be treated surgically. The leaflet also points that while there is some evidence from underdeveloped countries, especially Africa, that circumcision may reduce the risk of sexually transmitted infections, such as HIV and syphilis, there is no evidence that circumcision has any such protective effect in a developed country such as Australia. In any case, circumcision is no substitute for safe sex. The leaflet also notes that only a small minority of Australian boys are circumcised these days, nearly all for cultural and religious reasons, not for reasons of health.

Circumcision of minors “an assault”, says Swedish Paediatric Society

Circumcision of young boys for religious and non-medical reasons ought to be banned in Sweden, according to the Swedish Paediatric Society (Svenska barnläkarföreningen, BLF). In a statement submitted to the National Board of Health and Welfare (Socialstyrelsen), the society called the procedure an assault. “We consider it to be an assault on these boys,” Staffan Janson, chairman of BLF's committee for ethical issues and children’s rights, said to newspaper Göteborgs-Posten (GP). Removing a boy’s foreskin for reasons other than medical necessity is controversial in Sweden. After discussing the matter for several years, BLF has now concluded that the procedure ought to be banned on the grounds that the children are unable to form a decision in the matter. According to BLF and Staffan Janson, circumcision is an attack on boys’ bodily integrity. “It’s such a complicated and difficult question, but even so, we've decided that this is a procedure to be done away with,” Janson said. “It’s a mutilation of a child unable to decide for himself.”

A report on male health in Australia by the Australian Institute of Health and Welfare does not consider circumcision to be of the slightest relevance to male health problems, nor to the promotion of male health. The report, The Health of Australian Males (July 2011), runs through the major problems and issues facing men and boys in Australia and does not mention circumcision even once. According to the report, the most serious health problems experienced by males in Australia relate to nutrition, exercise, smoking, weight, mental problems such as depression, and violence. What any reasonable person must conclude from this significant silence is that “lack of circumcision” (that perverse expression so beloved by circumcision promoters) is not a factor in the health problems experienced by Australian men, and that more circumcision will do nothing to improve male health.

The Slovenian Human Rights Ombudsman has found that medically unnecessary circumcision of boys was a violation of the rights of the child. The statement posted on the Ombudsman website concludes: “Parents are primarily responsible for the development of children’s health, but also they must in all cases take into account the child's interest as a guide in decision making. Also, in deciding their rights [they] are limited by the rights of others, in this case, therefore, their children .... The right to religious freedom does not justify interference with the right to physical integrity of another person, so we believe that circumcision for non-medical reasons, may only be [with] the child’s consent, subject to the conditions provided for by law on patients’ rights, therefore, usually after 15 years of age.”

Last October the Journal of the American Medical Association published an opinion piece by Aaron Tobian and Ronald Gray, “The medical benefits of male circumcision”. It said nothing new, and was no more than a rehash of tired old assertions, fortified by more recent evidence from medical experiments on Africans that circumcision (of adults) could reduce a male’s risk of acquiring HIV during heterosexual intercourse with an infected (female) partner. This, apparently, was enough to justify – indeed, require – universal circumcision of infants in the United States. The fact that the World Health Organisation recommendations on this matter referred to circumcision (of adults, not children) only as an adjunct to AIDS control, and then only “in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence” (i.e. conditions not found in the United States) seems to have escaped their notice.

As you might expect, this poorly-argued effusion attracted a flood of critical comment, and you might also have expected that JAMA would have published at least a substantial selection of these in the interests of open-minded scientific debate. Not a bit of it! Showing very clearly where his sentiments lie, the editor published only 2 of the dozen or so critical letters submitted, followed by 2 letters supporting Tobian and Gray, plus a lengthy response in which they reasserted their case. We are deeply shocked by JAMA’s blatant suppression of opinions contrary to those of the editor, and in an attempt to break through the censorship we are making a selection of the letters available on our site. Readers can make up their own mind about who has the better of the argument.

Circumcision programs as American cultural imperialism?

The AsiaSentinel newspaper has warned that U.S.-inspired and funded circumcision programs in underdeveloped countries could be seen as American cultural imperialism.

"American exceptionalism takes many forms. One of the least noticed is the preference for circumcision of boys. Other than among Muslims and Jews, for whom it is a religious or at least traditional requirement, cutting off part of the penis is alien to most other cultures and usually only carried out for medical, or occasionally aesthetic, reasons. But the US is now trying to promote the practice in developing countries supposedly as a defense against AIDS. The Bill and Melinda Gates Foundation is supporting its propagation and the World Health Organization is being urged to do the same. The theory is that circumcised men have a roughly 50 percent less chance of contracting HIV. Assuming that is the case, adult men may reasonably decide whether they are at risk and if so whether the loss of the penis foreskin and possible impact on sexual enjoyment is worth the lowering of HIV risk. But any such campaign carries with it the real danger that societies in Africa, where the AIDS prevention efforts are mostly focused, will result in the large scale circumcising of infants who have no choice in the matter." ... Read full story at AsiaSentinel

The Flap over Circumcision, AsiaSentinel, Friday, 03 February 2012

More American madness: Tattoos on a boy are criminal, circumcising him is just dandy

A recent case in Georgia, USA, involves a mother who agreed to her 10-year old son’s request for a small tattoo on his arm in memory of his brother, killed by a speeding car. She has been arrested and faces gaol under cruelty to children laws. This absurd incident has caught the attention of a thoughtful moral philosopher at the Oxford University Centre for Practical Ethics, Brian Earp, who wonders about the blatant double standard in American law and custom:

“The truly troubling part involves a deep inconsistency in Georgia law regarding parental consent in general. This point can be made by offering a stark point of contrast. It is perfectly OK, under Georgia law, for a parent to consent to the surgical removal of her son’s foreskin, before he is able to form words or express an opinion, in a medically unnecessary, irreversible procedure which (as I have argued elsewhere) is deeply immoral and should be banned. Tattoos? No way. Invasive, medically useless, nonconsensual genital surgery? Go right ahead. So what is going on here? How can it be that neonatal circumcision is OK, and taking your baby daughter to have her ears pierced is fine – but allowing your 10-year old to memorialize his brother in the form of a tattoo lands you jail?”

No such thing as “male circumcision”

An essay on the Australian site On-Line Opinion argues that the expression “male circumcision” is misleading and deceptive because it implies that circumcision is always the same. The author, medical historian Dr Robert Darby, suggests that circumcision is more like sexual intercourse: legitimate in some circumstances, as illegitimate as rape or sexual assault in others. His article concludes:

"Even if all the benefits of circumcision claimed by its promoters were true, they would only amount to a case that might persuade a cautious adult to elect the procedure for himself. The case was never sufficient to justify doing it to children without consent. Individuals are entitled to make their own choices about how they manage their health, and should not be deprived of normal body parts merely because somebody else thinks they would be better off without them.

"It may be justifiable to perform circumcision on adults who have given informed consent, and even on children who cannot give consent in situations of therapeutic necessity (i.e. to correct a pathology that has not responded to conservative treatment); and it is arguable that it is justified if the parents are devout, conscientious, practising adherents of a religion which holds that children must be circumcised. Like sexual intercourse, it depends on the circumstances: with the consent of a person above the legal age of consent, sexual intercourse is justifiable; without consent, or if the person is below the statutory age, it is sexual assault or rape. There is no reason why the rules for permanent bodily alterations, particularly in such a physically and psychologically sensitive area as the penis, should be less strict than the rules for sexual activity."

Circumcised men more likely to have multiple partners and forget the condoms

From Africa there is ever-increasing evidence that men who have agreed to get circumcised because they have been told it will protect them from HIV infection believe they are immune. This is leading to an increase in high-risk behavior: increased promiscuity, multiple partners, more unsafe sex and failure to use condoms. As critics of the circumcision solution have warned from the beginning and emphasized on the rare occasions they have been allowed to get anything into print, such behavioural patterns are likely to increase the incidence of HIV infection, and at the very least must cancel out any benefits that might otherwise arise from the circumcision programs. As recent reports from Zambia, Kenya and Zimbabwe indicate, the much-vaunted circumcision programs are producing an epidemic of unsafe and high-risk sex, thereby defeating their own stated purpose.